James A. Moses

A neuropsychological study of early onset schizophrenia.

Characterizing a pattern of cognitive dysfunction in early onset schizophrenic patients may illuminate neurodevelopmental contributions to the illness. A cohort of chronically institutionalized schizophrenic patients with a variable range of age of onset (range 7-29 years) was administered a comprehensive battery of neuropsychological tests that included the Luria-Nebraska Neuropsychological Test Battery. After statistical control of age, parental socioeconomic class (SES) effects, and thorazine equivalents, age of illness onset was positively correlated with performance on measures of motor ability, perceptual motor and pure motor speed, receptive and expressive speech, and overall cognition function, and inversely related to severity of negative symptoms; that is, earlier age of onset was associated with worse cognitive performance and an increase in negative symptoms. This study demonstrates that an early age of onset in schizophrenic illness is associated with impairment on tasks which involve motor and language abilities, functions linked to the frontal, temporal, and subcortical regions of the brain. This association is not due to the effects of medication, negative symptoms, or duration of illness.

Symptomatology and cognitive impairment associate independently with post-dexamethasone cortisol concentrations in unmedicated schizophrenic patients

Serum cortisol concentrations were measured after dexamethasone administration (1 mg) in 21 neuroleptic-free schizophrenic inpatients. Patients were assessed using the Brief Psychiatric Rating Scale and a battery of cognitive tests. A significant correlation was found between negative symptoms and both 8:00 AM and 4:00 PM post-dexamethasone cortisol concentration (PDC). Cognitive impairment on several measures was also correlated with 8 AM PDC, but in an independent manner. Although positive and negative symptoms were unrelated, exploratory analysis revealed a significant inverse correlation between a positive symptom grouping and both 8:00 AM and 4:00 PM PDC.

Evaluating cognitive impairment in depression with the Luria-Nebraska neuropsychological battery: Severity correlates and comparisons with nonpsychiatric controls

Depressed patients often complain of memory and attentional difficulties, and some research suggests an increased incidence of neuropsychological impairment in depression. Yet, many prior studies contain methodological problems, including the following: (1) inclusion of medicated patients, (2) small sample sizes, and (3) tests with unknown psychometric properties. We administered the Luria-Nebraska Neuropsychological Battery (LNNB) to 28 unmedicated inpatients who met Research Diagnostic Criteria for major depression. Twenty of the 28 patients were given additional cognitive measures (e.g., Wechsler Adult Intelligence Scale-Revised, Benton Tests). The depressed patients performed similarly to an age- and education-matched nonpsychiatric reference sample. When data for a subset of the most severely depressed patients were analyzed separately, these patients too were found to perform similarly to matched controls. There were no relationships between Hamilton rating scale measures of depression severity and any cognitive measures among the depressed patients. The results suggest that cognitive functioning in depressed patients does not differ significantly from that in carefully matched controls and is independent of symptom severity.

Relationship of the Halstead-Reitan Neuropsychological Battery to the Luria-Nebraska Neuropsychological Battery.

One of the major questions that has arisen in the field of neuropsychology deals with the effectiveness of the Luria-Nebraska Neuropsychological Battery as compared with the Halstead-Reitan Neuropsychological Battery, which has been recognized by many as the preeminent standardized battery. The present study compared the major 14 scores of the Halstead-Reitan battery with the 14 summary scale scores of the Luria-Nebraska battery to investigate whether the batteries could predict one another and their effectiveness in a common sample of 48 brain-damaged and 60 normal patients. Discriminant analysis found both batteries equally effective in identifying brain damage, with hit rates over 85%. A high degree of relationship (all Rs > .71, p < .05) between the Luria-Nebraska scale scores and the selected 14 scores of the Halstead-Reitan was found. The recent introduction of the Luria-Nebraska Neuropsychological Battery, an attempt at the standardization of the qualitative work of the Russian neuropsychologist A. R. Luria, has elicited considerable interest from clinicians and researchers in the field of clinical neuropsychology. One of the major questions that has arisen is the relationship between the effectiveness of the Luria-Nebraska Neuropsychological Bat

CT measures of cerebrospinal fluid volume in alcoholics and normal volunteers

Cranial computed tomography (CT) scans were obtained in 46 male chronic alcoholics and 31 normal male volunteers. Automated methods were used to estimate the cerebrospinal fluid (CSF) volume in various intracranial zones. Measures of the ventricular fluid volume, the volume of fluid in cortical areas on CT sections at the level of the ventricles, and the sulcal fluid volumes on two convexity sections were computed. The alcoholic group, excluding subjects with chronic liver disease, had significantly more fluid than the control group on all sulcal measures. The group difference on the ventricular measure fell short of significance. Within the alcoholic group, no significant correlation was found between the number of years of alcoholism and any fluid measure when normal age effects were taken into account. A striking degree of variability in the sulcal volumes was observed within the alcoholic group, with many subjects showing normal values while a large group showed markedly elevated values. Further studies will be necessary to determine the significance of these variations.

MMPI measures of impulsivity and depression correlate with CSF 5-HIAA and HVA in depression but not schizophrenia

Recent studies have linked impulsivity with CSF concentrations of both 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA). One work found a negative correlation between the MMPI psychopathic deviate (Pd) scale and 5-HIAA in personality disordered men (Brown et al., 1982). We found that the 5-HIAA/Pd correlation extends (P less than 0.05) to unmedicated depressed patients (n = 21). A trend was found between HVA and Pd in depression. There was no relationship between either metabolite and the Pd scale in unmedicated schizophrenics (n = 24). A significant inverse correlation was found between the MMPI depression scale and CSF HVA but not 5-HIAA in the depressed patients.

Psychopathology and Limbic Epilepsy: Relationship to Seizure Variables and Neuropsychological Function

Summary: Correlations were sought among psychopathologic, neuropsychological, and seizure variables in 21 patients with limbic epilepsy. Observer‐based assessments, such as the Bear‐Fedio Inventory, and self‐report assessments of psychopathology were used. Self‐reported psychotic experiences were associated with increased seizure frequency. Increased religiosity was noted in patients whose epileptic focus included the left side. Increased neuropsychological impairment was associated with several measures of psychopathology, including those related to thought disorder, psychoticism, and affective disturbance.

Comparison of cognitive performance in RDC-diagnosed schizoaffective and schizophrenic patients with the Luria-Nebraska Neuropsychological Battery.

Controversy continues regarding the differential diagnostic distinction between schizoaffective disorder and schizophrenia, and there are few published studies that examine the neuropsychological performance of schizoaffective patients. We evaluated 52 RDC-diagnosed schizophrenic and schizoaffective patients with equal numbers of medicated and unmedicated patients using the Luria-Nebraska Neuropsychological Battery and additional cognitive measures. Both groups performed at cognitively impaired levels. The cognitive performance level of schizoaffective patients was indistinguishable from that of the schizophrenic patients. The RDC subtype of schizoaffective disorder (depressed or manic) also was not related to cognitive performance level. Findings are consistent with the notion that cognitive impairment is found in a significant portion of schizophrenic (and possibly schizoaffective) patients and that the presence of this deficit may characterize a specific subgroup of patients.

Luria-Nebraska performance and symptomatology in unmedicated schizophrenic patients

Recent attempts at subgrouping schizophrenia have emphasized negative symptoms (e.g., blunted affect, emotional withdrawal), and several works have suggested that patients with negative symptoms show greater cognitive deficits and structural brain abnormalities. However, many of these studies have relied on screening devices or single measures of neuropsychological performance. Accordingly, the present study used the Luria-Nebraska Neuropsychological Battery (LNNB) in assessing 38 unmedicated inpatients with a diagnosis of schizophrenia. The results found no relationship between LNNB performance and symptom ratings derived from clinical interviews using the Brief Psychiatric Rating Scale. The findings show that cognitive performance may be unrelated to symptomatology when a complex battery type test is used.

Neuroendocrinology and Limbic Epilepsy: Relationships to Psychopathology, Seizure Variables, and Neuropsychological Function

Summary: Correlations were sought among neuroendocrine, psychopathologic, neuropsychological, and seizure variables in 16 male patients with limbic epilepsy. Plasma prolactin and luteinizing hormone levels were directly correlated with seizure frequency. Plasma prolactin was inversely correlated with thought disorder. Post hoc findings included a strong direct correlation between total plasma testosterone levels and aggression. These relationships may help to elucidate mechanisms related to interictal symptomatology in patients with limbic epilepsy.